operational performance and all of the factors of production necessary to cost-effectively achieve that performance under the control of the CONTRACTOR.
4.0 SCOPE OF SERVICE 4.1 Scope of Service:
4.1.1. Exclusive Services. This AGREEMENT is entered into pursuant to the applicable State and County ordinances and regulations and in order to provide for the health, safety and welfare of the County’s constituents and visitors. With the limited exceptions
enumerated in this AGREEMENT, the County hereby grants CONTRACTOR as its sole source provider the exclusive and sole right to provide emergency ambulance services, inter-facility transfers, standby services and specialty care transport services within the County’s Exclusive Operating Area. The CONTRACTOR shall provide all emergency ambulance service, including ambulance dispatch, for the entire population of the identified Exclusive Operating Area in the County. In this system design, the County grants an exclusive franchise for all emergency ambulance service, with limited exceptions, through this AGREEMENT to the CONTRACTOR.
Ambulance services originating at or arranged by a hospital are covered under this AGREEMENT. Such services will be subject to the exclusivity, response-time, and pricing provisions of this AGREEMENT.
All ambulance services shall be provided at the advanced life support (ALS) level. Additionally, the CONTRACTOR shall furnish (a) stand-by coverage for special events; (b) inter-facility transfers; (c) critical care transport; (d) long-distance transfers originating within the County; (e) reasonable mutual aid services; (f) special contract services; (g) emergency standby services; and (h) communications and medical dispatch services.
CONTRACTOR shall submit to the County a plan for managing the increased needs of each special event that places an extraordinary demand on the CONTRACTOR.
4.1.2. Exceptions to Exclusive Scope of Service:
4.1.2.1. EMS Aircraft. EMS Aircraft services are provided by established public and private operators and will not be the responsibility of the CONTRACTOR. 4.1.2.2. Future Neonatal/Perinatal Specific Transport Program. County may grant limited special exceptions to the exclusive franchise by contracting with healthcare facilities and other ambulance operators to operate Specialized Critical Care for neonatal and perinatal ground transportation units. The County may determine that allowing another CONTRACTOR to provide these services is in the best interest of the public. If the County considers such an arrangement during the terms of this AGREEMENT, County and CONTRACTOR shall meet and confer regarding CONTRACTOR’S ability and suitability to provide such services and the potential economic impact of excluding them from providing the services. CONTRACTOR shall have the first right of refusal to provide these services provided they can implement the necessary service in a timeline determined by the County. CONTRACTOR shall not be excluded from entering into such arrangements if it is capable of providing the service.
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4.1.2.3. City of Carmel-By-The-Sea/Carmel Valley Fire Protection District/Fort
Hunter Liggett. The CONTRACTOR shall not be responsible for ambulance responses within the City of Carmel-By-The-Sea, the Carmel Valley Fire Protection District, or Fort Hunter Liggett except as requested for mutual aid. The CONTRACTOR will not be responsible for transporting inter-facility and discharge ambulance patients whose destination is within the City of Carmel-By-The-Sea or the Carmel Valley Fire Protection District, or Fort Hunter Liggett except as requested by the patient, the patient’s agent, or the patient’s physician.
4.1.2.4. Certain requests for ambulance transportation services may be made by the Monterey County Health Department, Behavioral Health Bureau. The CONTRACTOR shall not be responsible for those ambulance responses except for emergency transports only. Such requests shall be made utilizing an authorization process established and approved by the CONTRACTOR and County under this AGREEMENT. CONTRACTOR shall provide emergency ambulance services according to the response-time and other performance requirements of the AGREEMENT. The Behavioral Health Bureau shall only pay for authorized services that it requests in an amount that is equivalent to the current approved MediCal rates for ambulance services in effect on the date that
the transport is completedand only for those transports that are not reimbursable
by MediCal, Medicare or the patient’s private insurance plan. (Amended 2012) 4.1.2.5. CONTRACTOR may not use any of the County EMS system infrastructure or factors of production employed to provide service under this AGREEMENT for any other purpose, unless the CONTRACTOR first presents a plan, which includes a method of fairly allocating and offsetting costs, to the County and receives prior approval from the EMS Director. Under no circumstances shall outside obligations interfere with meeting the CONTRACTOR’S obligations to the County under this AGREEMENT.
4.2 Reporting Requirements - CONTRACTOR and County shall agree to meet and design all necessary and applicable reports within the first three months of the execution of the AGREEMENT. All reports shall be designed to meet the County’s established needs and requirements as outlined within this AGREEMENT, based upon the availability of the CONTRACTOR to provide the required reports and/or information. Reports shall include at a minimum but not be limited to the following:
4.2.1. Production Report- Summary of call volume, transport volume, unit hour
utilization and response time compliance, to be submitted by the 15th of the following
month.
4.2.2. Operations Report- Summary of operational activities to include, clinical performance, that shall include at a minimum, a summary of cardiac arrest resuscitation attempts, successful resuscitation, endotracheal intubation success rates and other such data as may be required by the EMS Medical Director, continuing medical education, public education and informational activities, investigations to inquiries with resolution,
4.2.3. Financial Report- Summary of average patient charge, monthly profit and loss
balance sheet, to be submitted by the 20th of the following month.
4.2.4. Communications Report- Summary of EMD requirements, investigations to inquires with resolution, critical equipment failures, and continuing education, to be
submitted by the 15th of the following month.
4.2.5. Miscellaneous Reports- CONTRACTOR shall comply with such other miscellaneous reporting requirements as may be specified by the County, provided that these additional reporting requirements shall not be unreasonably or excessively cumbersome to the CONTRACTOR. The CONTRACTOR shall provide an annual report to the Emergency Medical Care Committee (EMCC), Board of Supervisors, City Managers and Fire Chiefs Association to include, at a minimum:
• Overall annual billing statistics.
• Fee Forgiveness Program with usage breakdown. • Complaint and resolutions log summary.
• Changes in insurance carrier practices affecting future collections.
4.3 Equipment Furnished - County shall provide for the use of the CONTRACTOR the radio system infrastructure owned by the County, including radio frequencies and repeaters. CONTRACTOR shall provide all Federal Communications Commission (FCC) required Next Generation compatible mobile and portable radios for ambulances and field supervisor units. The mobile and portable radios shall be capable of communicating with all County, local government and state first responder agencies, as well as operating on State designated mutual aid channels.
4.4 CONTRACTOR-Provided Equipment - CONTRACTOR shall be required to provide all equipment and systems, other than the radio infrastructure identified above, necessary to fulfill the requirements of the AGREEMENT. Equipment and systems provided by the CONTRACTOR shall include, but are not limited to, the following: dispatch equipment, computer systems, mobile and portable radios, pagers, ambulances, supervisory vehicles, monitors, defibrillators, other clinical equipment, crew quarters, and administrative offices.
Mobile and portable radios shall be FCC required Next Generation compatible, be compatible with the evolving Monterey County Next Generation radio system, and be able to transmit and receive authorized County, local government and state frequencies. CONTRACTOR shall be required to install all necessary components of the Next Generation radio system, the Mobile Data Terminals (MDT) and AVL system if the CONTRACTOR has more than one year remaining on the AGREEMENT, upon successful installation and activation of the Next Generation (NGEN) Public Safety Voice and Data Radio System by the County.
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CONTRACTOR may submit a request for a rate adjustment to the EMS Director solely to cover the cost of implementing and maintaining, including the costs of ongoing operational system user assessments, for the Next Generation radio system, the MDT/AVL system or converting to a new radio system if the County changes radio systems as part of a conversion to a Next Generation system. No adjustments in rates shall occur without County prior written approval.
4.5 Provider-Provided Personnel - CONTRACTOR shall be responsible for providing all operational and clinical personnel employed to provide services under the AGREEMENT.
4.6 Performance vs. Level of Effort - This AGREEMENT requires a performance rather than a level-of-effort standard in performance of the AGREMENT. In accepting the CONTRACTOR’S proposal, the County neither accepts nor rejects the CONTRACTOR’S level-of-effort estimates; rather, the County accepts the CONTRACTOR’S financially guaranteed commitment to employ whatever level of effort is necessary to achieve the clinical, response time, and other performance results required by the terms of the AGREEMENT.
4.7 Quality Improvement and Medical Control - The CONTRACTOR’S electronic data system shall capture and report common data elements that are standard for the EMS industry, California Emergency Medical Services Information System (CEMSIS) and National Emergency Medical Services Information System (NEMSIS) Gold Standard data elements and those currently collected in the Monterey County EMS system. In addition the data system shall be capable of reporting the Emergency Medical Dispatch Determinate Code.
4.8 Records and Patient Care Reports - The CONTRACTOR shall operate and manage the data collection system in accordance with the County’s standards. The data system shall include, but not be limited to, the following generally described components and requirements. The CONTRACTOR shall make these and other records available upon verbal or written request of the County.
4.8.1. System shall create a uniform patient care report (PCR) form to the County specifications.
4.8.2. An electronic patient care report shall be completed for all ambulance responses and for all patients for whom care is rendered at the scene, regardless of whether the patient is transported. CONTRACTOR shall submit the contents of the patient care records to the EMS Agency electronically. Patient care records shall clearly identify those instances when two or more patients are transported in the same ambulance so that proper billing can be done. Round trip transports are to be counted as two transports.
4.8.3. In order to ensure that the County and EMS Medical Director can conduct system-wide quality improvement activities, the CONTRACTOR shall provide the EMS Agency with electronic copies of accurately completed patient care reports that meet the requirements outlined in Monterey County EMS policies and PCR completion guidelines. Patient care records shall be available to the EMS Agency immediately upon the record being filed as complete. Patient care reports shall be completed at the conclusion of patient care or, if the report is unable to be completed at that time, no later than within 24 hours of completion of the call or the end of the shift, whichever shall come first. If a patient care report is filed after this time period, a brief report describing the cause of the delay shall be filed with the EMS Agency.
4.8.4. CONTRACTOR shall provide all patient care records in an electronic format approved by the County. The Contractor shall implement an electronic patient care record system NO LATER THAN April 30, 2010. Any delay in implementation outside of CONTRACTOR’S control shall be reported to the County immediately. CONTRACTOR shall provide a detailed analysis of the system. The electronic software shall be made available to the Monterey County EMS Agency and CONTRACTOR shall provide a method to transfer all data related to this AGREEMENT to the County in a format acceptable to the County upon completion of this AGREEMENT or at any time the County requests it in the form of a written format. The County may implement an electronic patient care system prior to the implementation of this AGREEMENT. CONTRACTOR shall be required to utilize this system and to reimburse the EMS Agency for the cost of the system at a cost to be determined at a later date, upon successful activation by the County. Appropriate adjustments to the approved rates will be considered at that time. CONTRACTOR shall be required to maintain all ongoing costs of the system and the linkage to the CONTRACTOR’S billing software.
4.8.5. The EMS Agency shall have access 24/7/365 to the Electronic Patient Care Report (e-PCR) system for system monitoring and QI functions. The CONTRACTOR shall provide initial and ongoing training for designated EMS Agency staff.
4.8.6. The PCR created by the e-PCR system shall be considered a permanent record. 4.8.7. A process of report delivery shall provide a copy of the PCR to the receiving hospital upon or soon after patient transport by transport personnel. Once the PCR has been completed, it shall be immediately available in a printed or electronic format at the receiving hospital. A process shall be in place to provide the PCR to out of county hospitals.
4.8.8. The e-PCR system shall also include QI data collection and report capabilities. A wide variety of QI report templates shall be included in the e-PCR system. Required templates include Utstein Criteria, frequency of reported patient types (e.g. cardiac, respiratory, trauma and falls, etc.), and skill usage by CONTRACTOR’S employees. The e-PCR system will allow for customizable QI reports on an individual, agency, and system basis.
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4.8.9. The e-PCR system shall be easy to use for data and information entry. This shall be demonstrated to the satisfaction of the EMS Agency representatives prior to implementation. Criteria for ease of use includes having no identified ergonomic concerns, the ability to locate PCR screens and sections easily, the ability to tab through screens, ease of completion of data fields through the use of drop down menus, and the ability to save data to prevent loss of data should the program be closed. The system shall allow for mandatory completion fields. The system will not allow the PCR to be filed without completing these fields. The system shall advise users of incomplete PCR’s.
4.8.10. The PCR shall be immediately available for review and QI activities by the employer of the individual who created the PCR and by EMS Agency personnel. Designated staff at Monterey County hospitals shall have access to PCRs for patients transported to their facility. CONTRACTOR shall provide PCRs to the Monterey County paramedic base stations when the base station provided online medical control and the patient was not transported to their facility.
4.8.11. High priority information such as chief complaint, initial vital signs, and treatment provided shall be easy to locate on the PCR by receiving hospital staff.
4.8.12. Reports shall have a time and date stamp upon completion. If revised, the individual who revised the PCR shall be identified. Only the individual who completed the PCR shall have access to revise the PCR. Corrections, additions, and deletions to the PCR by the individual who created the PCR shall be permitted. These changes shall be identifiable.
4.8.13. e-PCR system shall be compatible with Tiburon CAD to allow for automatic data transfer of dispatch data to the PCR. Specific data to be transferred includes: Call address, Ambulance Run Number, time of dispatch, unit en-route to the scene, arrival at scene, transport, at the hospital, available, and cancelled. The EMD Determinate Code shall also be automatically transferred.
4.8.14. System shall be compatible with CONTRACTOR’S heart monitors currently in use in Monterey County to allow download of all captured data for review through the e- PCR system. The e-PCR system shall provide for multiple designated snapshots of the EKG to print with the PCR.
4.8.15. Data shall be stored in a secure server and backed up at least daily. All data shall also be sent to the EMS Agency as it is received. The use of redundant servers by the CONTRACTOR to back-up and store this data is required.
4.8.16. Entire system shall be Health Insurance Portability and Accountability Act (HIPAA) compliant. Data collected by the system shall have security features to limit access, as well as to grant access to all or part of the data to designated users. System users shall have access to all data that is entered by their personnel.
4.8.17. System shall regularly send all CEMSIS data to the EMS Authority in the EMS Authorities designated XML format. The frequency and method of sending this data shall be negotiated between the EMS Agency and the CONTRACTOR based on EMS Authority requirements.
4.8.18. System shall remain fully functional on a 24/7/365 basis. The CONTRACTOR shall provide technical support on a 24/7/365 basis. The EMS Agency Duty Officer shall be notified upon discovery that the system is not fully functional.
4.8.19. All patient care report data, both entered by users or derived through system logic, shall remain the property of the County and County may, at any time, request to have all data delivered in a non-proprietary format to County either electronically, on common or standard type media, or both. A complete copy of all system data must be delivered to the County within 30 days of the termination of any agreement.
4.8.20. Costs for the system, including ongoing maintenance, shall be borne by the CONTRACTOR. The CONTRACTOR shall not be responsible for purchase or maintenance of hardware used by other EMS responders. This shall not prohibit the CONTRACTOR from working with other EMS responders in joint purchasing arrangements or maintenance contracts in an effort to reduce first responder agency costs associated with implementing an e-PCR system.
4.8.21. System shall allow for multiple patients to each have a unique patient care report. 4.8.22. Monterey County trauma triage criteria shall be entered as a mandatory completion field for trauma patients.
4.8.23. The PCR system shall be compatible with and able to export data to National Fire Incident Reporting System (NIFIRS) reports through NIFIRS systems currently in place. 4.8.24. The system program shall incorporate established Monterey County EMS treatment protocols and have them available for review by EMS personnel. This feature shall allow for periodic updates.
4.8.25. Software shall be free of malicious code such as viruses, Trojan horse programs, worms, spy ware, etc.
4.8.26. System shall allow the completion of supporting documents such as a signed “AMA” form.
4.8.27. Field personnel shall be able to complete a PCR on another system device should